Abortion and Obamacare

A Washington University School of Medicine study predicts a 62 to 78 percent drop in the number of US abortions after full implementation of the Affordable Care Act’s no charge birth control provisions. Additionally, 15-19 year old girls enrolled in the university’s Contraceptive Choice Project had an 82 percent drop in birth rate compared to the national and St. Louis area averages. Part of the reason the Congressional Budget Office predicts the Affordable Care Act will lower our government’s budget deficit is the roughly $10,000 in Medicaid prenatal and delivery savings for each low-income pregnancy prevented. Longer term, breaking the cycle of teen-age pregnancies promises to have a significant impact on poverty in the US.

Logically, since everyone wants to reduce abortions in the US, this provision of the Affordable Care Act should have universal support. Unfortunately, logic is not a trait today’s Republicans share.

The abortion study

With a private $20 million grant, the Washington University School of Medicine in St. Louis, Missouri started the Contraceptive Choice Project in 2007. The study continued to 2011 and included 9,256 women and adolescents between the ages of 14 and 45 from the St. Louis area. Besides public advertising, the study also recruited women who had at least one previous abortion. While study participants represented all demographics, the goal was to recruit many “highly at risk” women for having unintended pregnancies.

From 2008 through 2010, annual abortion rates for women enrolled in the study ranged from 4.4 to 7.5 per 1,000 women. This compares to the national rate of 19.6 per 1,000 women in the same time period.  It also compares very favorably with the St. Louis city and county averages that fell from 17 to 13.4 per 1,000 women during the study.

Researchers also found when women were informed of the different birth control options available and could choose the one they wanted with cost not entering the equation, 75 percent chose long acting reversible contraceptives (LARCs). The study found that the LARC failure rate was 1/20th that of pills and other methods. Even though LARC costs are lower than other contraceptive choices, few adolescent women use them because of the high upfront cost. However, when offered free long acting reversible contraceptives, over 70 percent of program participants chose them.

Solution provider or enforcer of the unenforcible?
Solution provider or enforcer of the unenforceable?

After standardizing for race, age and socio-economic status, the study authors conclude, “changes in contraceptive policy simulating the Contraceptive CHOICE Project would prevent as many as 62–78% of abortions performed annually in the United States”.

The study, “Preventing Unintended Pregnancies by Providing No-Cost Contraception”, was published in Obstetrics & Gynecology: December 2012 – Volume 120 – Issue 6 – p 1291–1297 and is available free by clicking the link below.


The Republican/Catholic rebuttal

A number of criticisms were raised about the study. Some are listed below with bullet points and answers in sub bullet points.

  • Critics note the study did not have a control group. Comparisons are made using national and St. Louis averages. Since participants were picked because they did not want to become pregnant during the three-year study period, the results are skewed.
    • Study results found that the teenage group had 85% fewer unwanted pregnancies than national and St. Louis averages.  These results may be slightly skewed because of the study’s selection criteria. However, over 80 percent of teenage pregnancies nationwide are unintended. This shows the study and national average groups have a similar propensity to avoiding pregnancy.  Because instead of a control group, national and regional averages were used, one can quibble with the “85 percent fewer unwanted pregnancies” number. However, one can’t argue that unwanted teenage pregnancies are very significantly reduced with free access to long acting reversible contraceptives.
    •  Also, assuming the national average had a higher desire to become pregnant, their much higher abortion rate makes the reduced abortion results of study participants even more impressive.
  • Critics point out Washington University researchers took the study results and adjusted them to fit the race, age and demographics of the US. Critics suggest these calculations were done incorrectly in obtaining the 62-78 percent estimate of the drop in US abortions, if the Contraceptive Choice Project Study’s protocols were implemented nationwide. Critics question the accuracy of these adjustments and want access to the raw data.
    • Protecting participant confidentiality precludes making raw data available to the public. However, this is the responsibility of the journal’s reviewers to make sure these adjustments are statistically and mathematically correct.
  • Critics charge the use of effective birth control leads to more promiscuous sex and higher rates of Sexually Transmitted Infection (STI).
    • According to “The Contraceptive Choice Project: Recruiting Women at Highest Risk for Unintended Pregnancy and Sexually Transmitted Infection” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3003915/ “The proportion of participants with a self-reported history of STI diagnosis (including C. trachomatis, N. gonorrhoeae, T. vaginalis, syphilis, herpes, or HIV) was 28%. Although we did not observe a significant increase in self-reported history of STI over time, we did observe a statistically significant increase in the number of participants who tested positive for an STI (C. trachomatis, N. gonorrhoeae, or T. vaginalis) at their baseline enrollment session.
  • Some critics claim birth control pills, implants and IUDs can cause chemical abortions to newly conceived embryos. Critics contend all the Contraceptive Choice Project does is substitute an early abortion for a later one. Taking this a step further, Representative (R) Paul Ryan of Wisconsin is a co-sponsor of the Sanctity of Human Life Act defining life as beginning at conception. This “Personhood” Amendment would ban most contraceptives.
    • For most women and their families considering an abortion, the nuances of aborting a zygote they never knew existed is no comparison to the trauma of a first or second trimester abortion.
    • According to a Pew Research Center 2012 survey, 85 percent of the US general public believes contraceptive use is either morally acceptable or not a moral issue.  According to the same survey, 77 percent of Catholics in the US share this view.
  • “No healthcare professional or organization should be required to perform, provide for, withhold, or refer for a medical service against their conscience. This is especially true of the religious organizations that deliver a major portion of America’s healthcare, a service rooted in the charity of faith communities.”
    • The Catholic Church hierarchy developed the above statement. Unfortunately they seem completely isolated from rank and file Catholics.  A study by S.K. Henshaw published in Family Planning Perspectives in 1998 found that 28 percent of women getting an abortion identify themselves as Catholic. A Pew Research Center 2010 survey found 24.3 percent of the 2010 US population identifies themselves as Catholic. It appears Catholic women represent a higher proportion of women getting abortions than they are of the US population.
    • According to the Center for Disease Control, 99 percent of American women use birth control during their reproductive lifetime. According to a Guttmacher Institute study, 98 percent of sexually active Catholic women use some form of birth control banned by the church.
    • Catholic hospitals became dependent on government Medicare and Medicaid payments. They are taking their case to the Supreme Court complaining that to continue future government support; they are forced to violate their conscience by distributing birth control. Yet, these same Catholics have no problem forcing a woman to continue an unwanted pregnancy. There is no better example of arrogance masquerading as righteousness.
The Republican vission of governing.
The Republican vision of governing.

The Republican alternative is reversing Roe versus Wade or passing legislation outlawing abortions. These laws would be unenforceable. In our global world, the only way to effectively impose such a law is to ultrasound every woman of child-bearing age leaving the country and every pregnant woman again when she returns to make sure she didn’t get an abortion while outside the US.

Summing up

Eliminating a majority of the over one million abortions performed in the US, ending a cycle of poverty from teenage pregnancies that force young people to quit school and saving the government money all in one swoop is almost too good to be true. The Affordable Care Act doesn’t force anyone to use birth control. In true conservative fashion, smart government provides the means for all citizens to make their own choices and in so doing; greatly reduces two of our society’s biggest problems (abortion and poverty).

In contrast, liberals believe government has the power to change human behavior. Liberals also believe a large and obtrusive government (controlled by them) can make better decisions than individual citizens.  It is time to show today’s liberal big government Republicans the door.

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